CMS Releases Proposed PFS Rule for 2026

On July 14, 2025, CMS released the proposed Physician Fee Schedule (PFS) rule for CY2026.

Find the press release here:

https://www.cms.gov/newsroom/press-releases/cms-proposes-physician-payment-rule-significantly-cut-spending-waste-enhance-quality-measures-and

The press release lists several subcategory Fact Sheets, find the main one here:

https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-pfs-proposed-rule-cms-1832-p

The full rule will be published July 16 here:

https://www.federalregister.gov/public-inspection/2025-13271/medicare-and-medicaid-programs-calendar-year-2026-payment-policies-under-the-physician-fee-schedule

Laboratory

I don't see much of direct special relevance to laboratories.

Quality Measures

CMS is booting ten quality measures, many of them for being "severely topped out."  Not too surprisingly, a measure that encourages COVID vaccination is also being dropped.  There is also some rulemaking about topped-out measures (512.725(h)(3) and see also 414.1305.

Other measures are dropped because they are no longer aligned to clinical guidelines or the measure steward is bowing out.  

In section IV.A.4.d.1.b, propose to revise the definition of a high-priority measure to remove "health equity" criterion; to revise 414.1305.  Discussion at p. 959ff of the inspection copy (typescript) rule, noting "we believe that our [prior] definition of health equity was confusing."

There are ongoing changes in MIPS and other quality systems, which can affect conversion factors rates (how RVUs are converting to payment dollars.)  Category "Achieving Health Equity" to be removed from MIPS.

Direct Supervision - Virtual Now

CMS rewrites a section of 42 CFR 410.32, which gives supervision requirements for diagnostic tests (mostly meaning imaging tests like MRI paid in RVUs).  Direct Supervision may include "virtual presence of the physician" by audiovisual technology.